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General NPI Number Information
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NPI Number | 1154785384
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Entity Type | Individual
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Provider Name | JESSICA ANNE SLOSTAD M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/13/2016
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Last Update Date | 07/25/2019
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Provider Practice Location Address
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Address Line | 1650 W HARRISON ST
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City | CHICAGO
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State | IL
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Zip | 60612-3800
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Country | US
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Telephone | 312-942-7100
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Fax | 312-942-5727
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Provider Business Mailing Address
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Address Line | 200 1ST ST SW
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City | ROCHESTER
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State | MN
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Zip | 55905-0001
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Country | US
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Telephone | 507-284-2511
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 62622
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 036.149639
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License Number State | IL
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